Provider Demographics
NPI:1235679721
Name:EVANS INJURY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:EVANS INJURY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:RUEGGEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:571-606-9300
Mailing Address - Street 1:807 OAKHURST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3713
Mailing Address - Country:US
Mailing Address - Phone:571-606-9300
Mailing Address - Fax:
Practice Address - Street 1:807 OAKHURST DR
Practice Address - Street 2:SUITE A
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3713
Practice Address - Country:US
Practice Address - Phone:571-606-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-02
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009837111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty